血液透析滤过对维持性血液透析患者营养状况的影响

Effect of hemodialysis filtration on nutritional status of maintenance hemodialysis patients

目的观察血液透析滤过(HDF)对维持性血液透析(MHD)患者营养状况的影响。方法选择行MHD治疗血液透析患者46例,其中男性28例,女性18例;年龄19~80岁,平均年龄60.8岁;原发病,慢性肾炎21例,糖尿病肾病15例,其他病因10例。根据治疗方式不同,将患者分为HDF组28例、高通量血液透析(HF-HD)组18例。HF-HD组每周行3次HF-HD治疗,HDF组每周行2次HF-HD治疗和1次HDF治疗。比较两组患者开始接受治疗及治疗12个月后血清白蛋白、肾功能、电解质、血常规、C反应蛋白(CRP)、甲状旁腺激素等。应用生物电阻抗法,评估患者开始接受治疗及治疗12个月后身体质量指数、骨骼肌、上臂围度、上臂肌肉围度、内脏脂肪面积等营养指标变化。结果治疗12个月后HDF组白蛋白水平显著高于HF-HD组[(39.06±3.02)g/L vs(36.84±3.21)g/L],CRP低于HF-HD组[(4.44±5.34)mg/L vs(8.78±8.60)mg/L]。治疗12个月后HDF组白蛋白水平较治疗前显著提升,HF-HD组CRP指标较治疗前明显上升,差异有统计学意义[(37.14±3.69)g/L vs(39.06±3.02)g/L、(5.76±6.61)mg/L vs(8.78±8.60)mg/L。P<0.05]。治疗12个月后HDF组上臂肌肉围度显著高于HF-HD组[(24.07±1.94)cm vs(22.38±1.60)cm],HF-HD组骨骼肌及上臂肌肉围度较治疗前明显下降[(25.07±4.77)kg vs(21.74±3.29)kg、(23.81±1.53)cm vs(22.38±1.60)cm。P<0.05]。结论与单纯行HF-HD治疗相比,MHD患者增加每周1次HDF治疗,可保持肌肉质量及内脏脂肪量,减少与尿毒症和透析相关的炎症状态,改善患者营养状况,值得更大的推广和应用。

Objective To observe the effect of hemodiafiltration(HDF)on nutritional status in maintenance hemodialysis(MHD)patients.Methods A total of 46 hemodialysis patients performed MHD treatment were enrolled,which included 28 males and 18 females,aged 19-80 years old with mean age of 60.8 years old.There were 21 cases of chronic nephritis,15 of diabetic nephropathy and 10 of other causes.According to treatment methods,all of them were divided into HDF group(n=28)and high-flux haemodialysis(HF-HD)group(n=18).The HF-HD group was performed with 3 HF-HD per week,and HDF group was treated with 2 HF-HD and 1 HDF per week.The serum albumin,renal function,electrolyte,blood routine,C-reactive protein(CRP)and parathyroid hormone before treatment and 12-month post treatment between 2 groups were compared.The bioelectrical impedance method was used to evaluate the changes of body mass index,skeletal muscle,upper arm circumference,upper arm muscle circumference,visceral fat area and other nutritional indicators before treatment and 12-month post treatment.Results After treatment for 12-month,the albumin level in HDF group was significantly higher than that in HF-HD group[(39.06±3.02)g/L vs(36.84±3.21)g/L],and CRP was remarkably lower than that in HF-HD group[(4.44±5.34)mg/L vs(8.78±8.60)mg/L].In addition,the albumin level in HDF group was significantly higher 12-month post treatment than that before treatment,while CRP index in HF-HD group was significantly higher than that before treatment,and the difference was statistically significant[(37.14±3.69)g/L vs(39.06±3.02)g/L,(5.76±6.61)mg/L vs(8.78±8.60)mg/L.P<0.05].Moreover,the upper arm muscle circumference in HDF group was significantly higher than that in HF-HD group[(24.07±1.94)cm vs(22.38±1.60)cm],the circumference of skeletal muscle and upper arm muscle in HF-HD group was significantly lower than that before treatment[(25.07±4.77)kg vs(21.74±3.29)kg,(23.81±1.53)cm vs(22.38±1.60)cm.P<0.05],12-month post treatment.Conclusion It is demonstrated that compared with simple HF-HD treatment,MHD patients receiving 1 HDF per week could maintain muscle mass and visceral fat mass,reduce uremia and dialysis-related inflammation,and improve nutritional status.It is worthy of promotion and application.